HD in Carbamazepine overdose

Q:  What is the best way to assess the effectiveness of hemodialysis in carbamazepine toxicity? 

 Answer:  Unfortunately, hemodialysis (HD) is not very effective in carbamazepine toxicity as it is highly protein-bound. Although, as a last resort it can be employed but only high-flux hemodialysis may work or the use of albumin-containing dialysate. Continuous venovenous hemodialysis (CVVHD) can be employed in hemodynamically unstable patients but results may not be as desirable. 

Another option is to use charcoal hemoperfusion but it is not easily available at most institutions and is not as safe as regular HD. It may cause thrombocytopenia, coagulopathy, hypothermia, hypocalcemia, hypophosphatemia, and hypoglycemia. The data on plasmapheresis/plasma exchange is also very limited. 

If HD is employed to remove carbamazepine, the best way to know if it's working is to measure the concentration of carbamazepine in the dialysate.

Administration of soda bicarbonate with QRS measurement continues to be the mainstay of treatment in carbamazepine overdose (reference #2).

#toxicology

References:

1. Schuerer DJ, Brophy PD, Maxvold NJ, et al. High-efficiency dialysis for carbamazepine overdose. J Toxicol Clin Toxicol 2000; 38:321. 

2. Bradberry SM, Thanacoody HK, Watt BE, et al. Management of the cardiovascular complications of tricyclic antidepressant poisoning : role of sodium bicarbonate. Toxicol Rev 2005; 24:195.

3. Bek K, Koçak S, Ozkaya O, et al. Carbamazepine poisoning managed with haemodialysis and haemoperfusion in three adolescents. Nephrology (Carlton) 2007; 12:33.